I prescribe a few things to people in the clinic that raise my patients’ eyebrows. No more so than when I prescribe an herbal and nutritional formula for blood sugar levels to be taken in the morning to fix a problem centred around waking up at night.
I can just hear the voice my patient’s inner voice saying, “Oh my god, I’ve come to get my sleep sorted out, and this guy is giving me something to take when I wake up!”
I continue to prescribe them, though, because I’ve seen it work so often.
Studies have shown that low sleep quality affects glucose levels negatively, increasing something called dysglycaemia (imbalanced blood sugar levels), depending on the deviation of hours slept.[1]
This article will explore how taking some positive action to get your blood sugar levels can positively affect your sleep quality, especially the number of times you are waking up at night.
You already know sleep is critical, but what about its connection to obesity?
Yep, those sugar cravings you experience during the day may be caused by your sleep, affecting the quality of your diet and dietary intake, especially during your teens.[2] A fun fact is that a change in our taste buds drives the craving for unhealthy food caused by lack of sleep.[3] Put another way, lack of sleep changes your taste buds!
If you are interested in the science behind the sugar cravings aside from the change in your palette, then it comes down to how glucose transport is affected. GLUT1, the bus that glucose boards to travel to the brain, is downregulated by poor sleep quality. This transport issue means that ultimately less glucose is getting into your brain, creating quite the resource problem.[4] The solution, eat more glucose so the brain can get what it needs. An obvious consequence of succumbing to these unhealthy sugar cravings is obesity.
So why do we care about this so much when it comes to sleep?
The answer is that indulging in the unhealthy food cravings caused by lack of sleep then affects your sleep quality, making the problem worse the next day and the next, compounding itself in the process.[5]
To further amplify this, sleep deprivation also affects insulin’s ability to deal with glucose. A study showed a pretty alarming result in that just one night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways[6] – just one night of partial sleep deviation is all it takes.
Conversely, extending sleep and its quality positively affected your insulin’s effectiveness, reduced overall appetite, the desire for sweet and salty foods, and daily free sugar intake.[7]
I’ve lost count of how many patients looking to manage their weight better don’t sleep well.
Is it starting to make a little sense? Hopefully, the connection between sleep and your eating patterns is becoming more apparent, even before the nuts and bolts of hypoglycemia (low blood sugar) are considered. Something we’re going to look at now.
What are the symptoms of hypoglycemia?
Having low blood sugar can present itself in many ways during the day. I often ask patients to recount how they felt the last time they missed a meal. For most, it’s pretty clear how things change. But if you are unsure, here is a list of symptoms:[8]
- Pale skin (pallor)
- Sweating
- Shakiness or Tremor
- Hunger
- Anxiety
- Irritability (I believe the term is “hangry”)
- Headache
- Dizziness
- Confusion
- Disorientation
I also like to ask about energy levels during the day. If you generally feel low in energy before eating but then feel a big energy boost after eating, this can also signify some imbalanced blood sugar.
“Here he goes talking about what’s happening in the daytime again when I’m here to try and fix what’s going on at night. What’s with this guy?”
It’s most likely that what happens during the day is being mimicked at night
To illustrate this statement to patients, I create a hypothetical which we’ll go through now.
Imagine you had a minimal breakfast because you weren’t feeling the best digestively, thinking that you’d pick something up at some stage in the morning. Then, unexpectedly, you’re called into a meeting that runs over lunch.
As you sit in the meeting, it’s now been almost five hours since you’ve eaten anything. How would you feel? Would any of the symptoms listed above be relevant?
Now let’s extrapolate that out to nighttime. After going to bed at 10 pm (early for most in Hong Kong, remember this is hypothetical!), you find yourself waking up with a burst of adrenaline at 2 am, wondering what the hell happened. You feel disorientated, anxious for no reason and find it difficult to calm down.
The common theme between both of these scenarios is fasting. Waking up between 2 am and 3 am is extremely common for many of my patients, for some even earlier. Most of the time, this equates to having fasted between four and five hours.
Why does having low blood sugar cause me to wake up with such a jolt?
The answer is down to the relationship between your hormones and your blood sugar. When your blood sugar is below acceptable levels in the blood, your ever-present adrenal glands step up to increase your cortisol, adrenaline, and norepinephrine[9], which, when working together to increase your heart rate and get the blood pumping around the body. This burst of adrenaline sounds precisely like what you want to happen when trying to have a restful sleep but also explains why you might be waking multiple times a night.
Building on this, the same process of hypoglycemia causes inflammatory chemicals called cytokines to increase, forcing inflammation levels up in the blood. It gets better. Increases in a particular inflammatory cytokine called IL-1 has been shown in studies to increase the severity of hypoglycemia[10], making the whole process compound repeatedly.
This increase in inflammation can go some way to explaining why some people experience headaches in the morning, chronic fatigue, or mood changes on waking.
What evidence-based things can you do to help rebalance your blood sugar?
Herbal and nutritional formulas can be a great gateway to getting things back on track. Herbs such as Fenugreek, Nigella, Gymnema and Cinnamon all have significant effects on glucose transport, helping glucose travel around the body effectively.[11] [12] [13]
Nutritional supplementation can also be beneficial, with Vitamin B6 being an essential form of currency that helps the body metabolise glucose.[14] Chromium is also well-known for its role in managing glucose. A metanalysis, a review that looks at multiple studies and pools the information together to make a broader conclusion, found that chromium was beneficial for insulin and fasting glucose.[15]
In proper natural medicine form, it’s not all about capsules and tablets; exercise and time-restricted eating can help too.
Exercise in the case of blood sugar management is once again one of the significant interventions (let’s be honest, is there a time where exercise isn’t a promising lifestyle intervention?) that can improve your insulin sensitivity and blood glucose control.[16]
Intermittent fasting in the form of time-restricted eating has some clear benefits for managing fasting glucose and assisting with insulin resistance. A study using a ten-hour eating window and a fourteen-hour fast over eight weeks saw significant changes in fasting glucose levels.[17]
In a broader sense, preliminary research suggests that over sixteen weeks, time-restricted eating, this time with a ten or 11-hour eating window, helped improve sleep.[18]
Unfortunately, many studies with time-restricted eating have low sample sizes when writing this. They are pretty subjective, making it difficult to ascertain how this form of intermittent fasting makes a difference.
But as far as managing your blood sugar levels are concerned, it might be worth a try once the supplements have elevated you to a place where your lifestyle can take over.
Correcting your blood sugar can take a little while but can help you with more than just sleep
It’s no secret to anyone who has experienced poor sleep just how much it can impact the quality of your day. Multiple studies have proven this, with short sleep duration and insomnia symptoms associated with lower happiness levels in Chinese adults in Hong Kong.[19]
Most of the time, you can use herbal medicine to correct things, but in this article, we have explored what to consider when the sleep aids don’t work.
Balancing your blood sugar can profoundly affect your sleep/wake cycle but can also help you live a happier and longer life.
Diabetes is a significant cause of death in Hong Kong,[20] and its prevalence is rising quickly. The WHO report that people living with diabetes increased from 108 million in 1908 to 422 million in 2014.[21] This number is predicted to be around 537 million or one in ten adults in 2021, with further predictions hitting 643 million by 2030.[22]
This small rant about diabetes is all to say that your sleep disturbances may come as a two-fold blessing. One that allows you to fix your sleep in the short term and prevent the development of a more profound illness responsible for killing 6.7 million people in 2021 – 1 every five seconds.[23]
Once again, you have the power to control the outcome by making some of the changes listed above and seeking some help if you need it. You don’t have to suffer, but you may have to change a few habits along the way.
Hope this helps.
References
[1] Chojnacki KC, Kanagasabai T, Riddell MC, Ardern CI. Associations Between Sleep Habits and Dysglycemia in Adults in the United States: A Cross-Sectional Analysis. Can J Diabetes. 2018;42(2):150-157. doi:10.1016/j.jcjd.2017.04.009
[2] Kracht CL, Chaput JP, Martin CK, Champagne CM, Katzmarzyk PT, Staiano AE. Associations of Sleep with Food Cravings, Diet, and Obesity in Adolescence. Nutrients. 2019;11(12):2899. Published 2019 Nov 30. doi:10.3390/nu11122899
[3] Lv W, Finlayson G, Dando R. Sleep, food cravings and taste. Appetite. 2018;125:210-216. doi:10.1016/j.appet.2018.02.013
[4] 1762-P: Poor Sleep Quality Is Associated with Lower Absolute Cerebral Glucose Levels, THEODORA K. STANLEY, FELONA GUNAWAN, NANCY S. REDEKER, LIHONG JIANG, ANASTASIA COPPOLI, DOUGLAS L. ROTHMAN, GRAEME F. MASON, JANICEHWANG, Diabetes Jun 2020, 69 (Supplement 1) 1762-P; DOI: 10.2337/db20-1762-P
[5] University of Arizona Health Sciences. (2018, June 1). Sleep loss linked to nighttime snacking, junk food cravings, obesity, diabetes. ScienceDaily. Retrieved December 2, 2021 from www.sciencedaily.com/releases/2018/06/180601171900.htm
[6] Donga E, van Dijk M, van Dijk JG, et al. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. J Clin Endocrinol Metab. 2010;95(6):2963-2968. doi:10.1210/jc.2009-2430
[7] Henst RHP, Pienaar PR, Roden LC, Rae DE. The effects of sleep extension on cardiometabolic risk factors: A systematic review. J Sleep Res. 2019;28(6):e12865. doi:10.1111/jsr.12865
[8] Kalra S, Mukherjee JJ, Venkataraman S, et al. Hypoglycemia: The neglected complication. Indian J Endocrinol Metab. 2013;17(5):819-834. doi:10.4103/2230-8210.117219
[9] Kalra S, Mukherjee JJ, Venkataraman S, et al. Hypoglycemia: The neglected complication. Indian J Endocrinol Metab. 2013;17(5):819-834. doi:10.4103/2230-8210.117219
[10] Razavi Nematollahi L, Kitabchi AE, Stentz FB, et al. Proinflammatory cytokines in response to insulin-induced hypoglycemic stress in healthy subjects [published correction appears in Metabolism. 2009 Jul;58(7):1046. Kitabchi, Abbas Eghbal [corrected to Kitabchi, Abbas E]]. Metabolism. 2009;58(4):443-448. doi:10.1016/j.metabol.2008.10.018
[11] Vijayakumar MV, Singh S, Chhipa RR, Bhat MK. The hypoglycaemic activity of fenugreek seed extract is mediated through the stimulation of an insulin signalling pathway. Br J Pharmacol. 2005;146(1):41-48. doi:10.1038/sj.bjp.0706312
[12] Cao H, Graves DJ, Anderson RA. Cinnamon extract regulates glucose transporter and insulin-signaling gene expression in mouse adipocytes. Phytomedicine. 2010;17(13):1027-1032. doi:10.1016/j.phymed.2010.03.023
[13] Kumar PM, Venkataranganna MV, Manjunath K, Viswanatha GL, Ashok G. Methanolic leaf extract of Gymnema sylvestre augments glucose uptake and ameliorates insulin resistance by upregulating glucose transporter-4, peroxisome proliferator-activated receptor-gamma, adiponectin, and leptin levels in vitro. J Intercult Ethnopharmacol. 2016;5(2):146-152. Published 2016 Mar 1. doi:10.5455/jice.20160224051727
[14] Mascolo E, Vernì F. Vitamin B6 and Diabetes: Relationship and Molecular Mechanisms. Int J Mol Sci. 2020;21(10):3669. Published 2020 May 23. doi:10.3390/ijms21103669
[15] Asbaghi O, Fatemeh N, Mahnaz RK, et al. Effects of chromium supplementation on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2020;161:105098. doi:10.1016/j.phrs.2020.105098
[16] Amanat S, Ghahri S, Dianatinasab A, Fararouei M, Dianatinasab M. Exercise and Type 2 Diabetes. Adv Exp Med Biol. 2020;1228:91-105. doi:10.1007/978-981-15-1792-1_6
[17] Peeke PM, Greenway FL, Billes SK, Zhang D, Fujioka K. Effect of time restricted eating on body weight and fasting glucose in participants with obesity: results of a randomized, controlled, virtual clinical trial. Nutr Diabetes. 2021;11(1):6. Published 2021 Jan 15. doi:10.1038/s41387-021-00149-0
[19] Zhao SZ, Wang MP, Viswanath K, et al. Short Sleep Duration and Insomnia Symptoms were Associated with Lower Happiness Levels in Chinese Adults in Hong Kong. Int J Environ Res Public Health. 2019;16(12):2079. Published 2019 Jun 12. doi:10.3390/ijerph16122079
[20] https://www.chp.gov.hk/en/healthtopics/content/25/59.html, viewed 3rd December 2021.
[21] https://www.who.int/news-room/fact-sheets/detail/diabetes, viewed 3rd December 2021.
[22] https://diabetesatlas.org, viewed 3rd December 2021.
[23] https://diabetesatlas.org, viewed 3rd December 2021.
